LAM FACIAL PLASTICS

Hello Dr. Lam,
I know that you specialize in facial surgery only and my issue does not pertain to face, but I am hoping that you will be able to answer my questions nevertheless because my question is somewhat generic and relates directly to fat transfer, an area in which you are the utmost expert. I greatly respect your work. The results that you are consistently achieving for your patients are simply unique and the advice you provide to people here on this forum is amazing.
I am 42 years old, fit, muscular with stable weight. Two years ago I had a small liposuction of the chest. Unfortunately the surgeon was too aggressive in some areas and removed what feels like pretty much all the fat. There are no adhesions, no palpable scaring, but it does not look natural when I lift my arms up, and the skin feels, what I would best describe, as not attached to the underlying tissues. Because I am lean, the area does not require a lot of fat. Only a very thin layer and I am not looking for perfection but an improvement.
Here are my questions:
1) Is fat transfer possible in areas where liposuction was previously performed? Would possible lack of vascularizatation due to previous liposuction be a concern for the survivor of the fat? Is fat transfer of a very thin layer on chest possible? (I am not looking at enhancing my chest, only at correcting unnatural look).
2) Is it possible to achieve a layer of about 3 mm (that is all I need) that would last?

I have not found any surgeons even approaching your level of artistry and expertise, that is why I am posting in your forum. I know you are only performing facial surgeries, but there is no one that I trust more. Would you make an exception and be able to help me to correct my bad liposuction results? As I mentioned, I am looking for improvement, not perfection.
Thank you,
Peter

thanks for the kind words. here are my thoughts below in all caps:
1) Is fat transfer possible in areas where liposuction was previously performed? YES, NO PROBLEM. Would possible lack of vascularizatation due to previous liposuction be a concern for the survivor of the fat? NO, THAT SEEMS TO BE OK. Is fat transfer of a very thin layer on chest possible? (I am not looking at enhancing my chest, only at correcting unnatural look). I DON'T KNOW BECAUSE I HAVE NEVER HAD TO DO THAT. I HAVE ONLY PUT INTO AREAS OF LIPOSUCTIONING IN THE LOWER BODY. I ASSUME SO BUT I HAVE NO EXPERIENCE WITH THIS.
2) Is it possible to achieve a layer of about 3 mm (that is all I need) that would last? AGAIN DON'T KNOW. JUST TRYING TO BE HONEST. ALSO, IF IT IS TETHERING OR SOMETHING ELSE YOU ARE DESCRIBING WHEN YOU LIFT YOUR ARMS, I AM DOUBTFUL THAT A FAT TRANSFER WILL UNTETHER OR FIX THAT. I ALWAYS SAY THAT FAT GRAFTING IS INTENDED FOR NON-DYNAMIC PROBLEMS. WISH I COULD HELP YOU MORE THAN WHAT I HAVE STATED. AGAIN THANK YOU FOR THE KIND REMARKS.

Hello Dr. Lam,
Thank you very much for your answer.
No, there is no tethering at all. The area is just unnaturally thin. When my arms are down the pectoralis muscle "fills" it in, but not when the arms are lifted. Also, because the liposuction appears to have been performed in different depths, in some areas very closely under the skin, those areas feel like the skin is very thin and loose (it's hard to describe, the skin is not actually loose, but rather because it is thin it drapes and folds differently).
I don't have a lot of fat on me (around 1 - 2 cm max on the belly). Not a lot of fat needs to be added, but I have seen some videos where the surgeons extract what to me appears to be an incredible amount of fat to process it and fill in a relatively small area. What is the ratio of volume of fat extracted to fat filled. I.e. how much gets discarded due to processing? Also is some fat not good to use, e.g. belly fat, ...? The actual volume of the area needed to be filled I would guestimate to no more that about 50 - 100 ml. How much fat do you generally need?
Does the transferred fat generally move and feel like natural fat?
Could I contact you outside this forum to possibly discuss whether you could help me?
Thank you,
Peter

peter,
i really appreciate your trust in me. however, i really specialize in facial augmentation. i literally have no experience in what you are describing. my fear always is to disappoint a patient or mislead you about my experience in a certain area. i am hesitant to do it for you because i do not want to deliver a poor result. i have truly specialized and subspecialized my work so that i can give people the most specialized care possible. i feel in this case that i would not be doing that for you. i would like to respectfully decline this procedure for those reasons. i am certain you will find the right surgeon for you but i do not like to go into unchartered terrain since my entire life has been dedicated to facial work. the only thing i have done in the body is hand fat transfers and correction of bad lipo in the thigh area but the chest seems like a world away since it is not a divot but a whole chest that needs augmentation. i just don't feel comfortable with that. again, my apologies.
best,
sml

Thank you Dr. Lam,
I understand and respect your position.
I probably described the condition worse than it is. There are two areas, each about 2"x1.5". If I saw a minor improvement in this area I would be happy with the result. There is no complicated scaring or tethering. From my laymen point of view it is just adding a layer of about 3 mm of fat in this area.
I wish I knew of a surgeon that performs the fat transfer at your level of expertise and experience. There are many websites and clinics claiming that they perform fat transfers and many doctors willing to cut with unproven techniques, .... Unfortunately most are more marketing claims and cannot show real results. I haven't found anybody with the level of experience in this area that you have and anyone I would trust as much as you.
Regards,
Peter

thanks peter. i just don't have any experience in what you are wanting me to do. i am sure you will find the right doctor for you. truly best of luck with your endeavors.